In 1976 over 53 million Americans lived in roughly 900 rural counties, which together make up about 40% of the land mass of this country. These areas are characterized by low population density, a disproportionate share of the country's poor and elderly, and shortages of all kinds (Bayer, Caplan, Daniels, 1983). Most important, however, are the critical shortages of health manpower and health services delivery systems. In 1977 rural areas averaged less than one primary care physician for every 3,500 people. According to Bayer, Caplan, and D ....